Complete Health Indicator Report of Colorectal Cancer Deaths

Definition

The rate of death from cancer of the colon or rectum (ICD-10: C18-C21) per 100,000 persons.

Numerator

The number of deaths due to colorectal cancer for a given time period (ICD-10: C18-C21).

Denominator

The population in Utah or the U.S. for a given time period.

Why Is This Important?

Colorectal cancer is the second leading cause of cancer-related deaths in Utah and the U.S. When national cancer-related deaths are estimated separately for males and females, colorectal cancer is the third leading cause of cancer death behind lung and breast cancer for females and behind lung and prostate cancer for males. Deaths from colorectal cancer can be substantially reduced when precancerous polyps are detected early and removed. When colorectal cancer is diagnosed early, 90% of patients survive at least five years^1^.
Several scientific organizations recommend that routine screening for colorectal cancer begin at age 50 for adults at average risk. Persons at high risk may need to begin screening at a younger age. Routine screening can include either annual fecal occult blood test (FOBT), and/or flexible sigmoidoscopy every five years or colonoscopy every 10 years or double-contrast barium enema every 5 to 10 years. Studies have shown that FOBT testing, when performed every 1 to 2 years in people aged 50 to 80 years, can help reduce the number of deaths due to colorectal cancer by 15 to 33 percent^2,3^. The National Cancer Institute advises each individual to discuss risk factors and screening options with his or her health care provider. Medicare and many insurance plans now help to pay for colorectal cancer screening.[[br]]
[[br]]
----
1. American Cancer Society, Colorectal Cancer Facts & Figures 2017-2019 Accesed at: [http://www.cancer.org/acs/groups/content/documents/document/acspc-042280.pdf].[[br]]
2. Burch JA, Soares-Weiser K, St John DJ, et al. Diagnostic accuracy of fecal occult blood tests used in screening for colorectal cancer: A systematic review. ''Journal of Medical Screening'' 2007; 14(3):132-137.[[br]]
3. Ouyang DL, Chen JJ, Getzenberg RH, Schoen RE. Noninvasive testing for colorectal cancer: A review. ''American Journal of Gastroenterology'' 2005; 100(6):1393-1403.

Healthy People Objective C-5:

Reduce the colorectal cancer death rateU.S. Target: 14.5 deaths per 100,000 population

How Are We Doing?

The Utah colorectal cancer mortality rate has decreased steadily over the past several decades. The colorectal cancer mortality rate ranged from 20.1 per 100,000 population in 1980 to 10.6 per 100,000 population in 2017.
Colorectal cancer mortality rates increase with age. Utah women aged 55 to 64 had significantly lower mortality rates than Utah men in this age group (14.9 per 100,000 women compared to 22.5 per 100,000 men for years 2015-2017 combined).
Among health districts, between 2013 and 2017 the age-adjusted colorectal cancer mortality rate ranged from a high of 13.6 per 100,000 population in TriCounty Health District to a low of 8.0 per 100,000 in Summit Health District.
Looking at Utah Small Areas between 2013 and 2017, Ivins/Santa Clara had the lowest rate of 4.8 per 100,000. (*Note: Ivins/Santa Clara rate does not meet UDOH data reliability standards and should be interpreted with caution.) Woods Cross/West Bountiful and Daybreak had the highest rates of 27.1 and 27.5 respectively. (*Note: Daybreak rate does not meet UDOH data reliability standards and should be interpreted with caution.)

How Do We Compare With the U.S.?

The Utah age-adjusted colorectal cancer mortality rate has been consistently lower than the rate for the U.S. In 2017, the Utah colorectal cancer mortality rate was 10.6 per 100,000 population compared with the U.S. rate of 13.7 per 100,000 population.

What Is Being Done?

Screening for colorectal cancer has recently been identified by the Centers for Disease Control and Prevention (CDC) as a priority public health issue.
The the Utah Cancer Control Program (UCCP) monitors the use of colorectal cancer screening tests by Utahns through the statewide Behavioral Risk Factor Surveillance System (BRFSS), which is conducted annually.

Available Services

Coverage of colorectal cancer screening tests is required by the Affordable Care Act (ACA).
However, the ACA doesn't apply to health plans that were in place before it was passed (so-called grandfathered plans). You can find out your insurance plan's grandfathered status by contacting your health insurance company or your employer's human resources department. If your plan started on or after September 23, 2010, it is required to cover colonoscopies and other colorectal cancer screening tests. If a plan started before September 23, 2010, it may still have coverage requirements from state laws, which vary, and other federal laws.

Health Program Information

In June 2002, the Utah Cancer Control Program (UCCP) received a grant from the CDC to launch a statewide education campaign.
From 2009-2015, the UCCP received a CDC grant to begin offering colorectal cancer screenings to low-income and uninsured Utahns. In addition to the screening program, monies were used for educational and promotional activities. Education efforts serve to increase awareness about colorectal cancer and promote screening and early detection for Utahns aged 50 and older.
In addition, the Utah Department of Health initiated the Utah Cancer Action Network (UCAN), a statewide partnership whose goal is to reduce the burden of cancer. The mission of the UCAN is to lower cancer incidence and mortality in Utah through collaborative efforts directed toward cancer prevention and control. As a result of this planning process, objectives and strategies have been developed by community partners regarding the early detection of cervical, breast, and colorectal cancers as well as the promotion of physical activity, healthy eating habits, melanoma cancer prevention, and cancer survivorship advocacy.

Related Indicators

Relevant Population Characteristics

The risk of developing colorectal cancer increases with age. Lack of physical activity also contributes to a person's risk of developing colorectal cancer. Smoking, a low fiber and high-fat diet, low fruit and vegetable intake, excessive alcohol use, and obesity may also increase risk.

Health Care System Factors

Medicare will pay for an annual fecal occult blood test (FOBT), a flexible sigmoidoscopy every four years, and a colonoscopy every 10 years for persons with Medicare aged 50 or older who are at average risk for colorectal cancer. Medicare also covers surveillance of high risk patients (those with a personal history of colorectal cancer or adenomatous polyps or a history of colorectal cancer or adenomatous polyps in a first degree relative or those diagnosed with inflammatory bowel disease) with colonoscopy every two years.

Related Health Care System Factors Indicators:

Risk Factors

Risk factors for colorectal cancer include increasing age, inflammatory bowel disease, a family history of polyps or colorectal cancer, a personal history of polyps or colorectal cancer, and certain hereditary syndromes. Physical inactivity, a low fiber/high fat diet, obesity, excessive alcohol consumption, and tobacco use may all increase risk. A diet high in fruits and vegetables, hormone replacement therapy in post-menopausal women, and aspirin use may reduce colorectal cancer risk.

Data Notes

Codes used to define colorectal cancer: ICD-10 C18-21.
[[br]] *Use caution in interpreting rates for Males and Females 0-34. The estimate has a coefficient of variation >30% and is therefore deemed unreliable by Utah Department of Health standards.

Data Sources

Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2017

Colorectal Cancer Deaths by Local Health District, Utah, 2013-2017

Local Health District

Age-adjusted Death Rate per 100,000 Population

Lower Limit

Upper Limit

Note

Record Count: 14

Bear River

10.7

8.4

13.4

Central

10.2

7.3

13.8

Davis County

10.7

9.0

12.7

Salt Lake County

11.6

10.6

12.6

San Juan

11.5

4.8

22.9

*

Southeast

13.3

9.0

18.9

Southwest

11.5

9.7

13.8

Summit

8.0

4.3

13.8

Tooele

12.7

8.6

18.3

TriCounty

13.6

9.3

19.2

Utah County

10.4

8.8

12.0

Wasatch

10.5

5.2

18.9

Weber-Morgan

11.6

9.6

13.7

State of Utah

11.2

10.6

11.8

Data Notes

Codes used to define colorectal cancer: ICD-10 C18-21.[[br]]
Age-adjusted to U.S. 2000 standard population.[[br]]
^ ^*Use caution in interpreting, the estimate has a relative standard error greater than 30% and does not meet UDOH standards for reliability. For more information, please go to [http://ibis.health.utah.gov/pdf/resource/DataSuppression.pdf].[[br]]
Note: Prior to 2015 San Juan County was part of the Southeast Local Health District. In 2015 the San Juan County Local Health District was formed. Data reported are for all years using the current boundaries.

Data Sources

Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2017

Colorectal Cancer Deaths by Utah Small Area, 2013-2017

Utah Small Areas

Age-adjusted Rate per 100,000 Population

Lower Limit

Upper Limit

Note

Record Count: 103

Brigham City

15.7

9.4

24.6

Box Elder Co (Other) V2

9.6

3.0

23.1

*

Tremonton

7.4

2.4

17.4

*

Logan V2

7.8

4.4

12.9

North Logan

11.2

4.8

22.4

*

Cache (Other)/Rich (All) V2

16.8

9.5

27.5

Hyrum

**

**

Smithfield

9.0

2.4

23.1

*

Ben Lomond

12.5

8.5

17.7

Weber County (East)

13.3

8.2

20.3

Morgan County

**

**

Ogden (Downtown)

12.7

7.6

20.0

South Ogden

9.5

5.5

15.1

Roy/Hooper

13.1

8.2

19.7

Riverdale

12.1

6.7

20.0

Clearfield Area/Hooper

17.5

11.9

24.9

Layton/South Weber

8.5

5.4

12.8

Kaysville/Fruit Heights

7.7

3.8

13.9

*

Syracuse

11.6

4.5

24.2

*

Centerville

8.9

3.5

18.4

*

Farmington

7.9

2.8

17.6

*

North Salt Lake

9.8

3.4

22.0

*

Woods Cross/West Bountiful

27.1

12.5

51.2

Bountiful

9.0

6.0

13.0

SLC (Rose Park)

11.5

6.4

19.0

SLC (Avenues)

6.9

3.1

13.3

*

SLC (Foothill/East Bench)

6.2

2.8

12.0

*

Magna

13.4

6.3

24.8

*

SLC (Glendale) V2

16.3

8.4

28.4

West Valley (Center)

17.2

11.3

25.0

West Valley (West) V2

25.6

14.9

41.2

West Valley (East) V2

11.0

6.6

17.2

SLC (Downtown) V2

11.8

7.1

18.4

SLC (Southeast Liberty)

8.3

3.6

16.5

*

South Salt Lake

23.3

15.0

34.6

SLC (Sugar House)

8.7

5.0

14.1

Millcreek (South)

12.8

7.5

20.6

Millcreek (East)

9.5

5.3

15.7

Holladay V2

10.6

6.4

16.4

Cottonwood

9.0

5.6

13.8

Kearns V2

17.6

10.2

28.5

Taylorsville (E)/Murray (W)

16.4

10.8

24.0

Taylorsville (West)

9.8

5.3

16.7

Murray

12.0

7.4

18.4

Midvale

11.2

6.2

18.5

West Jordan (Northeast) V2

10.3

5.0

18.7

West Jordan (Southeast)

13.2

7.2

22.4

West Jordan (W)/Copperton

19.0

7.7

38.9

*

South Jordan V2

6.9

3.7

11.8

Daybreak

27.5

6.6

74.8

*

Sandy (West)

14.2

8.2

23.0

Sandy (Center) V2

10.7

5.4

19.0

Sandy (Northeast)

15.9

9.0

26.0

Sandy (Southeast)

5.7

2.0

12.4

*

Draper

9.8

5.2

16.8

Riverton/Bluffdale

12.6

6.9

21.3

Herriman

15.7

6.4

32.1

*

Tooele County (Other)

14.5

6.5

27.7

*

Tooele Valley

12.0

7.3

18.6

Eagle Mountain/Cedar Valley

24.9

8.4

56.9

*

Lehi

7.8

3.9

13.8

Saratoga Springs

12.1

3.7

29.1

*

American Fork

8.5

4.4

14.7

Alpine

15.2

5.5

33.5

*

Pleasant Grove/Lindon

11.3

6.7

17.8

Orem (North)

11.9

6.2

20.6

Orem (West)

9.5

4.5

17.6

*

Orem (East)

8.0

3.4

16.0

*

Provo/BYU

7.9

4.1

14.0

Provo (West City Center)

11.8

5.5

22.0

*

Provo (East City Center)

19.7

8.3

39.6

*

Salem City

**

**

Spanish Fork

15.9

9.0

26.2

Springville

10.3

5.1

18.6

*

Mapleton

**

**

Utah County (South) V2

11.0

2.8

29.1

*

Payson

10.0

4.5

19.2

*

Park City

5.6

2.1

12.2

*

Summit County (East)

14.8

5.7

31.0

*

Wasatch County

10.4

5.2

18.6

Daggett and Uintah County

14.8

9.3

22.5

Duchesne County

12.3

6.0

22.2

*

Nephi/Mona

17.6

6.4

38.6

*

Delta/Fillmore

**

**

Sanpete Valley

11.5

5.7

20.7

*

Central (Other)

14.2

8.2

23.0

Richfield/Monroe/Salina

6.4

2.3

13.8

*

Carbon County

14.2

8.1

23.0

Emery County

15.8

6.6

31.6

*

Grand County

10.9

4.3

22.9

*

Blanding/Monticello

13.2

4.0

31.8

*

San Juan County (Other)

**

**

St. George

9.4

6.9

12.6

Washington Co (Other) V2

13.8

6.6

25.5

*

Washington City

8.3

3.8

15.6

*

Hurricane/La Verkin

12.8

7.0

21.7

Ivins/Santa Clara

4.8

1.6

11.4

*

Cedar City

22.6

15.7

31.4

Southwest LHD (Other)

16.1

10.1

24.3

State of Utah

11.6

11.0

12.2

Data Notes

Age-adjusted to the U.S. 2000 standard population.
*Use caution in interpreting, the estimate has a relative standard error greater than 30% and does not meet UDOH standards for reliability. For more information, please go to [http://ibis.health.utah.gov/pdf/resource/DataSuppression.pdf]
**The estimate has been suppressed because 1) the relative standard error is greater than 50% or 2) the observed number of events is very small and not appropriate for publication.
A description of the Utah Small Areas may be found on IBIS at the following URL: [https://ibis.health.utah.gov/resource/Guidelines.html].

Data Sources

Population estimates produced by the UDOH Center for Health Data and Informatics. Linear interpolation of U.S. Census Bureau and ESRI ZIP Code data provided annual population estimates for ZIP Code areas by sex and age groups, IBIS Version 2017

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